UNITE PRIVATE NETWORKS
EMPLOYMENT APPLICATION

We are an Equal Opportunity Employer. Applicants for all job openings are welcome and will be considered without regard to race, color, religion, national origin, sex, age, sexual orientation, physical or mental disability, or any other basis protected by state, federal or local law. It is the intent of UPN to comply with all applicable federal, state and local legislation concerning equal opportunity in employment.

APPLICANT INFORMATION

Can you, after employment, submit verification of your legal right to work in the United States?

YesNo

Are you over 18?

YesNo

Are you a citizen of the United States?

YesNo

If no, are you authorized to work in the U.S?

YesNo

Do you have a valid Driver's License?

YesNo

Are you able to perform all of the tasks for the position you are applying for with or without an accommodation?

YesNo

If No, please describe below which tasks, if any, you will need an accommodation to perform, and explain what type of accommodation you require:

PLEASE LIST IN ORDER THE LAST SEVEN YEARS OF EMPLOYMENT BEGINNING WITH CURRENT EMPLOYER

Dates of Employment

FromTo

Base Rate of Pay

Start Rate of PayEnd Rate of Pay

Dates of Employment

FromTo

Base Rate of Pay

Start Rate of PayEnd Rate of Pay

Dates of Employment

FromTo

Base Rate of Pay

Start Rate of PayEnd Rate of Pay

CRIMINAL HISTORY

Disclosure of a criminal record or pending charges will not necessarily disqualify you from employment consideration. Each offense will be evaluated on its own with respect to time, circumstances, seriousness and relation to the position you are applying. Omission of information responsive to questions regarding criminal record or pending charges may disqualify you from employment consideration.

Have you ever been convicted, pled guilty or no contest to a crime other than a minor traffic infraction? Note: Crimes include misdemeanors, felonies and any other category of crime with the exception of traffic infractions. Driving under the influence, with a license or with a suspended license is NOT considered minor traffic offenses. Information regarding records sealed by a court of law need not be disclosed. Or, are you currently facing criminal charges of an kind?

YesNo

If yes, when? Please explain below:

APPLICANT STATEMENT RELEASE AND SIGNATURE

Please read carefully and sign below. Unite will treat this application for employment as active for a period of time not to exceed 60 days. If I wish to be considered for employment after 60 days have passed, I understand I must reapply.

I, certify that the information contained in this application is complete and correct to the best of my knowledge. I understand that falsification of this information or omissions are grounds for non-consideration of my application and termination at any time of any employment I may be offered by.

I also understand and agree to the following:

1.) My prior employers, educational institutions and other references listed on any application form or resume, and information provided in any conversation or interview with any employee of are authorized to give or a National Investigation Service of Unite’s choice any and all information concerning my previous employment and any pertinent information they may have. I release all persons or entities from all liability for any damage that may result from furnishing information to Unite. I also release Unite and all of its employees from all liability for any damage that may result from this reliance on the information furnished.2.) I hereby authorize Unite to obtain any and all information pertaining to my driving record. If necessary in my community, I also authorize Unite to obtain a criminal background check. I release the providers of such information and Unite and all of its employees from all liability for any damage that may result from furnishing or relying upon the information furnished.3.) To comply with the requirements of the Immigration Reform and Control Act of 1986, I must produce applicable documents showing that I am a United States citizen, or alien lawfully authorized to work in the United States, within the time frame specified by Unite.4.) No offer of benefits, which I may have discussed with Unite representatives, is binding unless I meet the requirements of the benefit plans.

If I fail to comply with any of the requirements set forth above, I understand that an offer or employment may be rescinded or my employment will be terminated.

In consideration of my employment, I will agree to conform to Unite’s policies, rules, and regulations. I understand and agree that my employment may be at-will, and therefore, my employment and compensation can terminate, with or without cause, and with or without notice, at any time, at my option or Unite’s option. I further understand and agree that this at-will employment relationship, as defined above, will remain in effect throughout my employment with Unite, or any of its parent or affiliated companies, unless it is modified only by a specific written employment with Unite, the information contained herein will become merged with the employment offer and my signature below indicates my understanding that my employment will be at-will.

Signature:

Date:

Resume or Cover Letter

Do you qualify for any of the categories below?

Person with a Disability - a person who has some particular impairment. This includes physical disabilities or other related disabilities.Disabled Veteran-disabled veteran means a veteran who is receiving at least 10% disability pay for a service-related element orDisabled Veteran-disabled veteran means a veteran who is receiving at least 10% disability pay for a service-relatedVietnam Era Veteran - Vietnam Era Veteran means a person who served on activity duty (not active duty for training) for a period of more than 180 days,any part of which occurred between January 1,1963 and May 7,1975 and was dischargedNot Applicable